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Title: How empowering is hospital care for older people with advanced disease? Barriers and facilitators from a cross-national ethnography in England, Ireland and the USA
Authors : Selman, L.E.
Daveson, B.A.
Smith, M.
Johnston, B.
Ryan, K.
Morrison, R.S.
Pannell, C.
McQuillan, R.
de Wolf-Linder, Susanne
Pantilat, S.Z.
Klass, L.
Meier, D.
Normand, C.
Higginson, I.J.
Published in : Age and Ageing
Volume(Issue) : 46
Issue : 2
Pages : 300
Pages to: 309
Publisher / Ed. Institution : Oxford University Press
Issue Date: 2017
License (according to publishing contract) : Licence according to publishing contract
Type of review: Peer review (Publication)
Language : English
Subjects : Empowerment; Inpatient; Hhospital; Aged; Palliative care; Older people
Subject (DDC) : 305: Social groups
362: Health and social services
Abstract: Background patient empowerment, through which patients become self-determining agents with some control over their health and healthcare, is a common theme across health policies globally. Most care for older people is in the acute setting, but there is little evidence to inform the delivery of empowering hospital care. Objective we aimed to explore challenges to and facilitators of empowerment among older people with advanced disease in hospital, and the impact of palliative care. Methods we conducted an ethnography in six hospitals in England, Ireland and the USA. The ethnography involved: interviews with patients aged ≥65, informal caregivers, specialist palliative care (SPC) staff and other clinicians who cared for older adults with advanced disease, and fieldwork. Data were analysed using directed thematic analysis. Results analysis of 91 interviews and 340 h of observational data revealed substantial challenges to empowerment: poor communication and information provision, combined with routinised and fragmented inpatient care, restricted patients’ self-efficacy, self-management, choice and decision-making. Information and knowledge were often necessary for empowerment, but not sufficient: empowerment depended on patient-centredness being enacted at an organisational and staff level. SPC facilitated empowerment by prioritising patient-centred care, tailored communication and information provision, and the support of other clinicians. Conclusions empowering older people in the acute setting requires changes throughout the health system. Facilitators of empowerment include excellent staff–patient communication, patient-centred, relational care, an organisational focus on patient experience rather than throughput, and appropriate access to SPC. Findings have relevance for many high- and middle-income countries with a growing population of older patients with advanced disease.
Further description : Erworben im Rahmen der Schweizer Nationallizenzen (
Departement: Gesundheit
Organisational Unit: Institute of Nursing (IPF)
Publication type: Article in scientific Journal
DOI : 10.1093/ageing/afw193
ISSN: 1468-2834
Appears in Collections:Publikationen Gesundheit

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